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General NPI Number Information
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NPI Number | 1689480576
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Entity Type | Organization
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Legal Business Name | GOLDEN RETREAT AT ICT
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 1320 N PERTH CT
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City | WICHITA
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State | KS
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Zip | 67208-2728
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Country | US
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Telephone | 316-730-3110
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Fax |
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Provider Business Mailing Address
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Address Line | 9306 E CARSON ST
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City | WICHITA
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State | KS
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Zip | 67210-2430
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Country | US
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Telephone | 316-730-3110
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHRISTINE NGYUN
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Credential |
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Telephone | 316-730-3110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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